This is a continuation of grant R01 DA07957 "The Effects of Prenatal Cocaine Exposure at School Age," a longitudinal study of the prenatal effects of cocaine/polydrug exposure (n=382;194 cocaine-exposed and 188 non-cocaine-exposed). This study, as well as others, has found differences among prenatally cocaine- exposed children that include deficits in perceptual reasoning, attention, language development and externalizing behavior problems compared to non-exposed children. The effects of environmental lead exposure and the differential impact of caregiver placement have been identified as important determinants of early developmental outcomes in this cohort, indicating the need for continued study at this developmental stage of newly emerging risk behaviors and social stress. We propose following this large cohort from age 15 through 18 years with the overarching objective of determining whether the negative effects of prenatal cocaine exposure on brain development continue to interfere with optimal developmental outcomes, and if cocaine exposure is associated with increased incidence of risky behavior, particularly substance misuse and mental health problems. Adolescents will be assessed using self and caregiver report, interview, bioassay and standardized assessments. Specific aims are to: assess the relationship of prenatal cocaine exposure to cognitive and behavioral outcomes (risk taking and mental health problems) in adolescence and to assess lead levels, iron deficiency, caregiving and environmental correlates of exposure;explore models that assess the relationship of early cognitive deficits and behavior problems to risk taking behaviors in an adolescent high-risk cocaine/polydrug exposed cohort;assess parenting experiences and behaviors of caregivers of cocaine- exposed and non-exposed adolescents;and assess the direct and indirect relationships of prenatal cocaine exposure to adolescent behavioral outcomes. Our model focuses on the mediating effects of earlier deficits in cognitive performance, attention and inhibitory control on risk taking behavior and the moderating effects of gender. Effects of lead exposure, iron deficiency and caregiving environment will be explored using structural equation modeling (SEM) and path modeling. The results of this study will provide the basis for designing culturally sensitive interventions prenatally or early in life that could reduce risky teen behaviors and ultimately reduce serious lifelong health problems including substance dependence, trauma and HIV infection. PUBLIC HEALTH RELEVANCE: A pattern of attention, behavioral regulation and cognitive problems among prenatally cocaine-exposed infants and children has been identified by this research group as well as others. Results indicate that fetal exposure to cocaine may have specific effects on brain development that can be observed in early cognitive and behavioral outcomes and that outcomes are also influenced by level of environmental lead exposure and caregiving quality. This study hypothesizes that the pattern of deficits found in childhood may translate into greater risk taking behavior including substance misuse and mental health problems in adolescence that can have grave consequences on adult productivity and health. Further research on prenatally cocaine-exposed adolescents will identify key points for the timing and focus of intervention and provide important content for public health messages.